Many individuals who suffer significant childhood trauma find that they have extreme difficulties forming and maintaining positive relationships with others in adulthood (including being drawn into further abusive relationships). These concise articles explore reasons why early life trauma may have such devastating effects as well as explaining what these effects may be.

In this particular article, however, I will concentrate upon a variant of obsessive compulsive disorder (OCD) called relationship obsessive – compulsive disorder(ROCD) ; in those afflicted by this psychological condition the individual’s obsessive-compulsiveness is centered around a relationship with another person (this relationship may be current or in the past).

What Are The Symptoms Of Relationship Obsessive-Compulsive Disorder (ROCD)?

The person suffering from ROCD experiences chronic, distressing, intrusive thoughts, images and urges that are not wanted and that interfere with the individual’s day-to-day functioning. Often, too, these obsessive thoughts / images / urges contravene the individual’s conscious beliefs, values and moral principles.

When particular urges / images / thoughts arise, the individual may feel compelled and driven to carry out certain behaviors /actions in an (irrational) attempt to prevent these urges / images / thoughts from leading to some dreaded consequences and to reduce anxiety.

Obsessions connected to relationships that the ROCD sufferer may experience :

whether they really love their partner or not / whether or not they are ‘right’ to love their partner

whether their partner really loves them or not (e.g. the individual with ROCD may constantly seek reassurances, their partner’s approval etc.) / whether their partner is ‘right’ to love them

whether or not they are in the ‘right’ relationship

whether their partner is having an affair / being unfaithful

intense anxiety about ending a relationship

intense focus upon the partner’s faults (as opposed to concentrating on the good in him/her)

constantly thinking (despite the relationship being good) they could be missing out on the opportunity of finding someone better

constantly fearing they’re not good enough for their partner and it is only a matter of time before s/he realizes this

Possible causes of ROCD :

Various factors may combine and interact with one another to cause ROBT ; these include :

Extreme emotional detachment can operate as an unconscious defense mechanism to help us cope with traumatic experiences including, of course, childhood trauma (such as emotional, sexual and physical abuse). If it is necessary for us to employ this coping mechanism for extended periods of time, it can become a deeply ingrained and pervasive part of our psychological make-up and we may continue to use it to protect ourselves from potential, emotional harm for the rest of our lives.

More frequently, however, those who have learned to detach emotionally as a way of mentally escaping the psychological pain of their adverse childhood experiences go on to develop serious difficulties with adult relationships due to a deep mistrust of others and a general fear of intimacy ; furthermore, such individuals may come across to others (including family members) as ‘cold,’ ‘aloof’, ‘distant’ and ’emotionally unavailable’.

Other symptoms of being cut off from emotions include a lack of emotional intelligence, a tendency to have a preference for logical and rational thinking styles and a propensity tointellectualize potentially emotionally charged subjects.

Suppression of emotions may also result in dysfunctional, ‘compensatory’ behaviors including promiscuous sex / sexual addiction, drug / alcohol abuse and gambling.

Furthermore, it is now also known, thanks to neuroscientific research, that those who have suffered childhood trauma and have, subsequently, been diagnosed with a depressive illness are at risk of also having suffering disruption to the part of the brain’s neurobiological system which is responsible for the generation feelings of love and trust.

Oxytocin : The ‘Love Hormone’ :

More specifically, those who have suffered ongoing childhood traumaare at risk of having lower levels of the neurohormone oxytocin than average. Oxytocin is released into the brain in response to social interaction with others including affectionate physical contact (e.g being hugged, caressed, sex etc) or through warm and loving verbal exchanges that increase emotional bonding and attachment with a trusted other.

Possible Positive Effects Of Naturally Raised Levels Of Oxytocin :

If, then, due to our experience of childhood trauma, we have lower than average levels of oxytocin, it can frequently be in our interests to attempt to raise them (I list the potential benefits of doing so below) :

The possible positive effects of raising our levels of oxytocin include :

increased levels of social confidence

decreased feelings of both emotional and physical pain

decreased need for approval from others

increased levels of enjoyment derived from social interactions

decreased proneness to feelings that life is not worth living

increased levels of trust

increased motivation to behave ‘pro-socially’

increased psychological stability

increased ability to relax

increased inclination to exercise warm and loving maternal care

increased ability to bond with one’s partner

increased speed of wound healing

increased generosity

improved sleep

increased resilience to depression

Animal Study Suggesting Anti-Depressant Effects of Oxytocin :

A study (Norman and Karelina, 2010) involving mice with a small injury showed that those left to recover alone were more likely to develop depressive symptoms (e.g. quickly giving up on challenging tasks) than mice who were allowed to recover in pairs; the study concluded that that the paired mice were more resilient to depression because of raised levels of oxytocin induced by the companionship of their co-recovering rodent friend.

Paradoxical Effects :

Recent research suggests that invariably identifying the release of oxytocin into the brain as a helpful biological process is an over-generalization.

This is because it has now been found that the release of the neurohormone may be paradoxical in as far as it may also sometimes have negative effects.

For example, it may exacerbate painful memories of previous, dysfunctional relationships (e.g. one study found that bad memories of one’s difficult relationship with one’s mother in early life were actually worsened by increased levels of oxytocin).

Another possible negative effect is that it may make us less accepting of those who are not part of our social group or culture (thus increasing feelings of prejudice against others).

Intensification Of Salience Of Social Interactions :

Bringing together the above information as a whole, it appears that it is too simplistic to regard the function of oxytocin as solely relevant to the accentuation of feelings associated with love.

Instead, it should be seen as relevant to how we perceive the salience of our relationships / social interactions with others – both good and bad.

REACTIVE ATTACHMENT DISORDER :

REACTIVE ATTACHMENT DISORDER may occur when a child is severely neglected where the neglect involves being deprived of close, consistent, stable care and nurturing from those who would normally provide it (i.e. a parent or primary caregiver). For example, a child who is raised in an orphanage in which the child has no sole, main carer, but, instead, a variety of overworked carers who work in shifts would be at increased risk of developing the disorder.

There are two types of REACTIVE ATTACHMENT DISORDER ; these are :

INHIBITED REACTIVE ATTACHMENT DISORDER

DISINHIBITED REACTIVE ATTACHMENT DISORDER

Let’s look at each of these in turn :

THE TWO TYPES OF REACTIVE ATTACHMENT DISORDER : INHIBITED AND DISINHIBITED :

INHIBITED REACTIVE ATTACHMENT DISORDER :

A child suffering from inhibited reactive attachment disorder may commonly suffer a range of symptoms which include :

a preference for solitary play / no interest in games that involve interaction with others

avoidance of / detachment from others (including an avoidance of any physical contact with others)

avoidance of eye contact

appears sad and lethargic

lack of any positive response to attempts by others to give comfort / does not seek comfort from others

does not smile

failure to reach out when picked up

DISINHIBITED REACTIVE ATTACHMENT DISORDER :

A child suffering from disinhibited reactive attachment disorder may commonly suffer a range of symptoms which include

behaving much younger than chronological age / taking part in activities appropriate to much younger children

MORE ABOUT THE CAUSES OF REACTIVE ATTACHMENT DISORDER :

I have already touched on the causes of reactive attachment disorder in the opening paragraph of this article. However, to elaborate further, a baby / young child does not only require his/her physical needs to be met (such as being fed or having his/her nappy changed) but also requires SIMULTANEOUS WARM EMOTIONAL INTERACTION WITH THE CAREGIVER WHO IS PERFORMING THESE PHYSICAL TASKS.

Such warm, emotional interaction is less likely to occur in underfunded and under-resourced orphanages (as already mentioned above). Also, however, young children who are forced to undergo frequent changes in foster homes, or who live with severely mentally ill parents, or with parents with serious substance misuse problems, are also at higher risk of extreme emotional neglect and, consequently, at increased risk of developing reactive attachment disorder.

WHO SUFFERS FROM REACTIVE ATTACHMENT DISORDER ?

Research into reactive attachment disorder has focused on babies / young children between the ages of 0 and 5 years of age. It is not certain if the disorder exists in children over the age of 5 years ; more research needs to be conducted in order to establish whether or not it does.

However, some preliminary research suggests that older children and adolescents may express symptoms of reactive attachment disorder through :

callousness

lack of emotional responsiveness

cruelty towards animals

cruelty towards people

general problems relating to their behavior

CAN REACTIVE ATTACHMENT DISORDER BE SUCCESSFULLY TREATED?

Although there is currently no one, specific, specialized treatment or therapy for reactive attachment disorder, the evidence is that, with the right kind of intervention, children suffering from the disorder can learn to form healthy relationships with others.

As with all psychological problems, the earlier the therapeutic intervention is made, the higher its probability of success.

Therapies likely to be helpful include :

individual counselling

classes in parenting skills

family counselling

education of caregivers about the disorder

education of parents about the disorder

NOTE : The DSM IV refers to the inhibited and disinhibited forms of the disorder as : emotionally withdrawn and indiscriminately social/disinhibited subtypes , whilst the DSM 5 refers to them as two separate disorders, namely, reactive attachment disorder and disinhibited social engagement disorder. SEE TABLE BELOW :

If we were rejected as a child by parents/primary caregivers we are at high risk of growing up into adults with serious abandonment issues. This means we will be hypersensitive to rejection by others, deeply afraid of such rejection and profoundly hurt and distressed when we experience it.

Because we may be preoccupied with, or even obsessed by, the fear of rejection and abandonment we are likely to be constantly on ‘red alert’, looking for the smallest signs that someone may reject us.

Frequently, too, because of our constant anticipation that we are going to be rejected, we may believe we perceive signs of rejection where, in reality, they do not exist.

Rejection by others is so painful to us as it reminds us (consciously or unconsciously) of the intensely traumatic abandonment we experienced in childhood; therefore, when we are subsequently rejected in adulthood, we are, in effect, re-traumatized.

Being intensely fearful of rejection can have numerous adverse effects on us. For example:

– we may become extremely ‘clingy’

– we may need constant reassurance from others that they are not going to leave us

– we may socially withdraw so that we don’t get close to others in order to avoid the risk of rejection

– we may be unconsciously motivated to reject others before they get the opportunity to reject us

– we may feel constantly insecure

– in extreme cases we may threaten/attempt suicide in response to signs of rejection from others

Internalization:

Due to rejection in childhood, many with abandonment issues have inferred from this (erroneously) that they must be ‘bad’ people and have then gone on to deeply internalize this mistaken view of themselves. This means such individuals tend to have both extremely low self-esteem and confidence.

Also, wrongly believing themselves to be ‘bad’, they may feel constantly guilty, expect others to somehow ‘sense’ their ‘badness’ and, therefore, perpetually feel their ‘badness’ will be exposed and that they will, as a result, become social pariahs

Some may become excessively reliant on drink and/or drugs in an attempt to alleviate the emotional pain they feel.

Emotional Abandonment:

Finally, it should be noted that being abandoned as a child need not involve actual physical abandonment; it can, instead, involve emotional/psychological abandonment – this may come about by growing up with a parent who is cold and distant or who ignores his/her child.

Therapies:

Three therapies which may help with abandonment issues are dialectical behavior therapy and EMDR (Eye Movement Desensitization And Reprocessing).

Do you find you have a tendency to fall in love with those who are very unlikely to reciprocate your love? Or those who are highly likely, sooner or later, to reject you? Or those with whom a relationship would be frankly all but impossible? Or entirely impossible?

Have I ever had such an experience? Well, as our American cousins might say: don’t even go there, dude! (I learned that expression by watching Breaking Bad and now consider myself bilingual).

But seriously.

If the first paragraph is applicable to you, it could be that you are unconsciously driven to fall in love with such people due to your childhood experiences. I explain below:

Rejection And Repetition Compulsion:

It has been hypothesized (originally by Freud, but also by much more recent researchers) that if we suffer a terrible trauma in childhood, such as parental rejection, we will (on an unconscious level) be compelled to put ourselves through similar experiences in adulthood (in this case, by engineering situations in which we are bound to be rejected again, either in ways described above, or by behaving in sucha manner that forces the other person to reject us).

Why should we be unconsciously driven to behave in such a self-destructive and despair – inducing manner?

A leading theory (again, originating from Freud but endorsed by later researchers) is that we are unconsciously attempting to gain mastery over such trauma.

Because such re-enactment of the original rejection is unconsciously compelled, this may explain why we fall in love with the ‘wrong’ person time and time again and seem utterly incapable of learning from bitter experience.

Of course, the trauma we re-enact need not be restricted to parental rejection. Indeed, another example comes from human sexuality; it has been theorized that those traumatized by being spanked in childhood may incorporate ‘spanking behaviour’ (to coin a phrase) into their adult sexual relationships – blissfully unaware of why they’re induced to behave in this somewhat abstruse, esoteric and recondite manner.

Understanding our unconscious drives and becoming aware of how they influence our behaviour is the first step to freeing ourselves from their tyranny.

It is thought that about 2-3% of individuals within the U.S. suffer from avoidant personality disorder (AvPD).This disorder can often be linked to childhood emotional neglect.

Those who suffer from the disorder tend to be preoccupied with the faults and failings they perceive in themselves and to exaggerate, in their own minds, these faults and failings (if, indeed, they objectively exist rather than being the imaginings of a self-lacerating personality). To compound this problem, they are also prone to minimising, or dismissing altogether, their strengths and positive qualities.

They are also likely to avoid any job that involves significant interaction with other people so are likely to select careers in which they are largely left to their own devices (such as a computer programmer or writer).

Further, they suffer from very low self-esteem and greatly lack confidence; indeed, they are likely to view themselves as deeply inadequate and fundamentally flawed.

They are highly sensitive and find social interaction extremely uncomfortable, fearing ridicule, criticism and rejection. They feel they have nothing to offer others and that others will immediately dislike them and view them, essentially, as uninteresting non-entities. Often, too, they fear others will see them as ‘weird’, ‘peculiar’ or ‘odd’ due to their self-consciousness and general unease.

If forced to be in a social situation, they are likely to excessively, even obsessively, self-monitor, so concerned are they that they may say or do something that humiliates them. As a result, frequently, they will be taciturn and may speak with much hesitation, stammering and stuttering.

They tend, too, to mistrust others.

In some cases, they may also be agoraphobic, staying at home by themselves living in an internal world of the mind which may well include elements of fantasy.

Avoidant personality disorder can be particularly cruel as, often, those who suffer from it have a deep desire and need to connect emotionally with others.

Causes of avoidant personality disorder (AvPD):

Onset of avoidant personality disorder is usually during the late teens. Those who have suffered childhood emotional neglect (i.e. shown little or no love, affection, approval or interest) from their parents are at higher than average risk of developing it, especially if they have been rejected by one or both parents.

Indeed, my own mother rejected me when I was thirteen years old so I went to live with my father and step-mother for several years who could barely tolerate my presence and essentially ignored me for half a decade (except to point out my faults which were, it seems, inordinate). Apparently I was ‘sullen’, ‘morose’ and ‘hostile’. A ‘clot’, a ‘nincompoop’ and ‘buffoon.’ ‘Ungodly’ and in all likelihood ‘evil’, quite possibly demonically possessed and in urgent need of an exorcism (in other posts I have written of how my step-mother shouted at me in what she believed to be, or possibly faked, ‘tongues’, when I was thirteen and had just moved in with her and my father, and how she would tell me that both she and her biological son could ‘sense evil in the house’ whenever my friend, Steve, had been round to see me). And, it goes without saying, I apparently had no redeeming features whatsoever, let alone any mitigation regarding my abhorrent behaviour.

To this day, I feel like an extremely awkward, excessively self-conscious teenager in the company of others. I suppose as a child I internalised the view that I was neither likeable nor interesting, nor, for that matter, even wanted.

Once such a self-view takes root, it is very hard to dislodge, almost like trying to change the color of your eyes by a sheer act of will.

More On Causes

Evolutionary psychology (the study of why behaviours evolve) explains in part the behaviour of those who suffer from AvPD. Our ancestors developed the ‘fight or flight’ response to things that they feared, and, as individuals with AvPD, at root, fear other people, they can become hostile to others (reflecting the ‘fight’ response), or do their best to avoid others (reflecting the ‘flight’ response). However, research suggests that ENVIRONMENTAL factors play a larger part in the development of AvPD than genetic factors (Millon and Everly).

– PARENTAL REJECTION : according to research conducted by the psychologist Kantor, parental rejection is the environmental factor which is most strongly associated with an individual’s later development of AvPD. This is borne out by the fact that those who suffer from AvPD are far more likely than others to have experienced rejection; furthermore, their experiences of rejection have commonly been found to be particularly intense and frequent.

Parental rejection will often set up the mindset (either consciously or unconsciously) in the rejected individual which runs along the lines of : ‘If my parents can’t accept me, how can I possibly expect anybody else to?’ This can have a catastrophic effect upon the person’s self-esteem, self-worth and confidence. It will often, too, lead the individual to become profoundly self-critical, even to the point of self-hatred.

– PEER REJECTION : if, when we are young, our home environment is rejecting, critical, hostile and undermines our sense of self-worth, but, on the other hand, outside of the home we have many experiences which are positively reinforcing to us (eg supportive teachers, friends or other social networks), the latter experiences may enable us to develop sufficient PSYCHOLOGICALRESILIENCEto protect us from the worst emotional effects of our home-life.

However, if a young person is rejected not only by parent/s, but, also, by siblings and peer group, AvPD is far more likely to develop in later life, especially if the various rejections continue over a sustained period of time.

The experience of continual rejection and humiliation can lead to the individual internalizing others’ negative view of him/her (ie coming to see him/herself in the same negative light in which others appear to see him/her).

This leads him/her to become yet more self-critical and to feel even more inferior. These feelings of worthlessness lead to even greater withdrawal from others, and, thus, increases to an even greater extent the person’s loneliness and sense of isolation. In the mind of the person becoming increasingly cut off from society, the rejection by his/her peers seems to justify and validate the parental rejection. In the end, the individual may retreat so far from others that AvPD develops.

OTHER POSSIBLE PARENTAL CONTRIBUTIONS TO THE DEVELOPMENT OF AvPD :

1) INFANTALIZATION

2) TRANSFERENCE

I briefly outline these two possible contributors to the development of AvPD below :

– INFANTALIZATION : parents who infantalize their children (i.e are overprotective and don’t let the child develop a sense of self-responsibility) may make it hard for that child, as s/he grows up, to relate to others outside of the family on equal terms. This may lead to the individual becoming regressive and/or dependent in extra-familial relationships.

– TRANSFERENCE : (‘transference’ refers to the psychological mechanism whereby we transfer a feeling we have for somebody close to us onto a different person. An example would be a person who fears his/her father later transferring that fear onto authority figures in general, such as their boss at work). Transference can lead to avoidance behaviour when the person with AvPD distances him/herself from others who remind him/her of someone s/he was afraid of as a child (usually a parent).

TREATMENTS

As has already been discussed, those suffering from avoidant personality disorder will generally endeavour to avoid social contact with others as a strategy to prevent themselves being rejected and rebuffed. Over time, others become aware of this aloofness, and, frequently, will likewise avoid him/her (this has been termed ‘reciprocal avoidance’).

Worse still, especially if young (at school, for example), s/he may attract the attention of bullies who may apply derogatory names to him/her (eg ‘loner’ etc) as they see him/her as an easy target and perhaps as too timid to stand up for him/herself. Adults, too, who suffer from AvPD, may be similarly discriminated against, albeit often in a more subtle manner.

Those with AvPD often find themselves trapped within a vicious cycle : his/her withdrawn and aloof behaviour leads to others not being well disposed towards him/her, this in turn leads to lowering the self-esteem of the AvPD sufferer further, which, in turn, leads to further withdrawn behaviour…and so on…and so on… As the cycle continues, the problem becomes increasingly intensified.

Because the person with AvPD is hypervigilant for any possible signs of rejection, as well as being hypersensitive to such, this can often lead to him/her perceiving rejection where none, objectively speaking, exists; or else s/he may greatly exaggerate and magnify minor signs of rejection. In the mind of the person with AvPD, any signs of rejection are deeply personal – they see the perceived rejection as confirming the ‘fact’ that they are a bad and worthless person. They assume that the perceived rejection is based on an in-depth and accurate analysis of their personality (whereas, in reality, it is much more likely to be due to superficial reasons, because the perceived rejector is in a bad mood, or for any number of reasons that are not personal in relation to the person with AvPD.

It has been pointed out by the psychologists Millon and Everly that conditioning is at play in the development of AvPD; specifically, a type of conditioning known by psychologists as NEGATIVE REINFORCEMENT. A behaviour which is NEGATIVELY REINFORCED is one which becomes associated with avoiding an undesirable outcome. In the case of the individual with APD, the behaviour which is negatively reinforced is aloofness as it can help the individual avoid the undesirable outcome of rejection. The more a behaviour is reinforced in this way, the more ingrained the behaviour becomes.

POSSIBLE TREATMENTS AND THERAPIES :

3 types of treatment available for AvPD are :

1) Behavior Therapy

2) Family Therapy

3) Medication

Let’s briefly look at these in turn :

1) Behaviour Therapy – this form of therapy involves the therapist encouraging the person with AvPD to interact with others in social situations for longer and longer periods of time whilst giving him/her support, encouragement and positive reinforcement.

2) Family Therapy – earlierI described how the development of AvPD might be contributed to by the sufferer having been ‘infantalized’ by his/her parents. If this is suspected to be the case, family therapy may be appropriate.

3) Medication – doctors sometimes prescribe anti-depressants to those suffering from AvPD which can help reduce the anxiety contributing to the condition.